Gãy xương không đủ sức chịu lực dưới sụn, gãy xương không đủ sức chịu lực dưới sụn kèm theo hoại tử xương, và các tổn thương xương dưới sụn khác có vẻ như tự phát ở đầu gối - sinh bệnh học và chẩn đoán qua hình ảnh

Insights into Imaging - Tập 14 - Trang 1-22 - 2023
Jacques Malghem1, Frédéric Lecouvet1, Bruno Vande Berg2, Thomas Kirchgesner1, Patrick Omoumi3
1Department of Radiology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
2Department of Medical Imaging, Clinique CHC Montlégia, Liège, Belgium
3Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland

Tóm tắt

Gãy xương không đủ sức chịu lực dưới sụn (SIFs) và SIFs kèm theo hoại tử xương (SIF-ONs) ở đầu gối (trước đây bị gọi nhầm là hoại tử xương tự phát ở đầu gối (SONK)) là các tổn thương xương xuất hiện mà không có sự kiện chấn thương, khối u hoặc viêm trước đó. Cả hai tình trạng này đều được đặc trưng bởi tình trạng phù xương tủy (BME) giống như tín hiệu ở chụp MRI trong các giai đoạn sớm. Tuy nhiên, trong khi SIFs thường tự lành, chúng cũng có thể tiến triển thành hoại tử xương (tức là SIF-ON), có thể dẫn đến sự sụp đổ không thể hồi phục của bề mặt khớp. Phân tích cẩn thận các dấu hiệu MRI khác có thể giúp phân biệt hai tình trạng này trong giai đoạn sớm. Ở SIFs, tín hiệu giống như phù BME mở rộng đến khu vực ngay lập tức bên cạnh mặt phẳng dưới sụn, trong khi ở SIF-ONs, khu vực dưới sụn này cho thấy cường độ tín hiệu thấp trên hình ảnh MRI nhạy cảm với dịch do tủy xương bị biến đổi. Độ dày và chiều dài của các khu vực dưới sụn có cường độ tín hiệu thấp nhạy cảm với dịch là những yếu tố quan trọng xác định tiên lượng của SIF-ONs. Nếu chúng dày hơn 4 mm hoặc dài hơn 14 mm, tiên lượng sẽ kém. Chẩn đoán phân biệt của SIFs và SIF-ONs bao gồm các tổn thương xương liên quan đến "hội chứng đau khu vực phức tạp" (CRPS), hoại tử xương đầu dưới sụn có nguồn gốc hệ thống, và các tổn thương liên quan đến bệnh lý sụn.

Từ khóa

#Gãy xương không đủ sức chịu lực dưới sụn #hoại tử xương #chẩn đoán hình ảnh #đầu gối #phù xương tủy

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